Provider Demographics
NPI:1255415105
Name:EHL, DAVID K JR (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:EHL
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 LAZY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1886
Mailing Address - Country:US
Mailing Address - Phone:310-798-3477
Mailing Address - Fax:310-798-3469
Practice Address - Street 1:6700 INDIANA AVE
Practice Address - Street 2:STE 100
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4290
Practice Address - Country:US
Practice Address - Phone:951-341-6565
Practice Address - Fax:951-341-6569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22323AMedicare PIN